NSAIDs  -  Non steroidal anti-inflammatory drugs



Risk factors for GI complications with NSAIDs

Patient related factors

  • Age >60 years
  • History of ulcer disease
  • History of IHD or ↑BP - the use of NSAIDS is associated with AF [BMJ 2011]

Drug related factors

  • Use of relatively toxic NSAID (not Diclofenac has be proven to be twice as toxic as Ibuprofen1.)
    • Diclofenac is contra-indicated in patients with CCF, IHD PVD or cerebro-vascular disease.
  • High dose of NSAIDs used concurrently.
  • Use of anticoagulant.
  • Concurrent use of corticosteroid.

NSAID Protection Strategies

  • Use lowest possible doses of NSAIDs
  • Use safer NSAIDs (Ibuprofen)
  • Alternatively consider
    • Cox-2 inhibitors such as Mesulid
      • Made in Ireland, cheaper than Diclofenac[Ref]
      • Contra-indicated in severe heart failure
      • Caution in hypertension and in patients with a oedema for any other reasons
    • Proton pump inhibitors
    • Misoprostil.

Cautions / contraindications

Contra indications

  • History of hypersensitivity to Aspirin or any other NSAID
  • (asthma, angio-oedema, urticaria or rhinitis precipitated by Aspirin or any other NSAID)
  • Active peptic ulceration.
  • Diclofenac is contra-indicated in patients with CCF, IHD PVD or cerebro-vascular disease.
  • High dose of NSAIDs used concurrently.
  • Use of anticoagulant.

Cautions

  • In the elderly
  • Renal, cardiac or hepatic impairment (causing a deterioration of renal function)
  • Coagulation defects
  • During pregnancy   (or breast feeding)
  • History of IHD or ↑BP - the use of NSAIDS is associated with AF [BMJ 2011]

Prescribing in the elderly

All patients should be advised to seek a review of their analgesic requirements by their practice nurse or GP after two days

Please read sections above.

For soft tissue injuries consider:

  • Paracetamol in full dose.
  • Alternatively Ibuprofen at 400 mg tds.
  • Both Paracetamol and Ibuprofen as above.

Content by Dr Gavin Lloyd, Dr Íomhar O' Sullivan 04/ 03/2002.   Reviewed by Dr Íomhar O' Sullivan 10/07/2004, 25/07/2005, 26/05/2006.   Last review Dr ÍOS 3/12/18.